Doctors keep searching for a magic bullet to cure pre-eclampsia. But evidence suggests the best preventative is a good diet with ample amounts of all nutrients.

Pre-eclampsia is, according to the medical profession, an enigma. It has been known by many different names around the world. It has been called toxaemia, pre-eclamptic toxaemia (PET), pregnancy induced hypertension (PIH), hypertensive disease of pregnancy (HDP), metabolic toxaemia of late pregnancy (MTLP) and even gestosis. The overabundance of names should be enough to indicate a certain amount of confusion about what exactly it is and how it develops. Although most antenatal tests are designed specifically to look for signs of pre-eclampsia, nearly 30 per cent of cases are first detected in labour, either because they were missed by antenatal screening or because the condition did not manifest until then.

The first indication which doctors look for is hypertension (raised blood pressure). Should a woman also have raised levels of uric acid in the blood and oedema (swelling due to water retention), there is cause for concern. Together, these symptoms generally indicate pre-eclampsia; singly, they do not usually pose a threat.

If early symptoms of pre-eclampsia are left untreated, protein may eventually appear in the urine. Even diagnosing this can be hit and miss the dipsticks used to detect protein in a woman's urine have a 25 per cent false positive rate when only traces of protein are indicated (Enkin, M, et al. A Guide to Effective Care in Pregnancy and Childbirth, Oxford University Press, 1995).

When protein appears in a pregnant woman's urine, clots and fatty acids begin to build up in the placenta, interfering with its efficiency and eventually causing it to cease functioning altogether. When the placenta is not functioning properly, the baby is not getting essential oxygen and nutrients, and growth retardation is a real possibility. Under these circumstances the body may, as a survival mechanism, instigate labour prematurely.

In mild to moderate forms, pre-eclampsia does not pose a particular threat to either mother or baby particularly if carefully monitored. However, one in 2000 cases of pre-eclampsia can develop into eclampsia, a potentially lethal condition for both mother and baby. Early symptoms of eclampsia include severe headaches, flashing lights, nausea, vomiting and pain in the abdomen. In extreme cases, the mother may experience fits, convulsions and, more rarely, go into a coma and die.

Many years ago, it was believed that the symptoms were the result of toxic agents in the body, thus the name pre-eclamptic toxaemia. Other theories include the idea that some placentas have narrower blood vessels than others, thus predisposing the mothers to the disease; that in some mothers the immune system views the baby as a foreign body and is trying to reject it; and that what we call pre-eclampsia is a normal physiological adaptation to pregnancy.

But perhaps the single biggest factor which has been linked to pre-eclampsia is poor diet: if a woman is malnourished and living in a stressful environment, the risk is even greater. Unfortunately, many practitioners are ignorant of what constitutes a proper diet for pregnancy. When nutrition is studied, the research shows an obsessive focus on single nutrients, like magnesium, given in isolation, instead of a holistic dietary approach.

In the meantime, the published evidence on diet is very clear. The only clinicians who have managed to completely eradicate pre-eclampsia are those who have taken steps to ensure women are fed properly. This means receiving daily high protein in the form of milk, eggs and meat, as well as daily servings of leafy green vegetables and fruit. The daily calorie intake should be around 2,800 and should include 80-100 g of protein.

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